66 year old male patient who is admitted with refractory heart failure.
Symptom onset was 9 months earlier.
Creatinine of 2.4 mg/dl
LV dysfunction by echo with EF of 24 % and stage 3 diastolic dysfunction.
A cardiac cath was considered but given renal function…..
You would recommend:
A. Medical management with referral for to advanced heart failure therapies.
B. Consideration for revascularization given large amount of myocardium at risk.
C. Referral for STEM cell therapy.
D. ICD prophylaxis.